The Global Pregnancy Collaboration (CoLab) symposium on short- and long-term outcomes in offspring whose mothers had preeclampsia: A scoping review of clinical evidence

Abstract

Preeclampsia is a maternal syndrome characterized by the new onset of hypertension after 20 weeks of gestation associated with multisystemic complications leading to high maternal and fetal/neonatal morbidity and mortality. However, sequelae of preeclampsia may extend years after pregnancy in both mothers and their children. In addition to the long-term adverse cardiovascular effects of preeclampsia in the mother, observational studies have reported elevated risk of cardiovascular, metabolic, cerebral and cognitive complications in children born from women with preeclampsia. Less clear is whether the association between maternal preeclampsia and offspring sequelae are causal, or to what degree the associations might be driven by fetal factors including impaired growth and the health of its placenta. Our discussion of these complexities in the 2018 Global Pregnancy Collaboration annual meeting prompted us to write this review. We aimed to summarize the evidence of an association between maternal preeclampsia and neurobehavioral developmental disorders in offspring in hopes of generating greater research interest in this important topic.

Keywords: autism; cerebral palsy; fetal growth restriction; intrauterine growth restriction; neurodevelopmental disorder; preterm delivery.

Figure 1

Conceptual model of the antecedents, correlates and potential sequelae in offspring of mothers with preeclampsia. (A) Pre-conception/environmental factors are associated hypertensive pregnancy disorders and developmental disorders; (B) Either by shared underlying mechanism or confounding, preeclampsia is often associated with fetal/placental diseases, congenital anomalies detected at birth, and downstream inflammation-related illnesses after birth; (C) Largely depending on the length of gestation (and therefore co-occurrence with fetal growth problems), preeclampsia is associated with heightened risks of multiple developmental disorders and also chronic cardiovascular disease.